Byron Bernal

The role of the arcuate fasciculus in conduction aphasia

In aphasia literature, it has been considered that a speech repetition defect represents the main constituent of conduction aphasia. Conduction aphasia has frequently been interpreted as a language impairment due to lesions of the arcuate fasciculus (AF) that disconnect receptive language areas from expressive ones. Modern neuroradiological studies suggest that the AF connects posterior receptive areas with premotor/motor areas, and not with Brocas area. Some clinical and neurophysiological findings challenge the role of the AF in language transferring. Unusual cases of inter-hemispheric dissociation of language lateralization (e.g. Brocas area in the left, and Wernickes area in the right hemisphere) have been reported without evident repetition defects; electrocortical studies have found that the AF not only transmits information from temporal to frontal areas, but also in the opposite direction; transferring of speech information from the temporal to the frontal lobe utilizes two different streams and conduction aphasia can be found in cases of cortical damage without subcortical extension. Taken altogether, these findings may suggest that the AF is not required for repetition although could have a subsidiary role in it. A new language network model is proposed, emphasizing that the AF connects posterior brain areas with Brocas area via a relay station in the premotor/motor areas.

The connectivity of the superior longitudinal fasciculus: a tractography DTI study.

PURPOSE The left superior longitudinal fasciculus (SLF) has been felt to link receptive with expressive language areas. The latter is located in the pars opercularis (Brocas area) of the left inferior frontal gyrus. We report the findings with tractography of the SLF in a group of normal volunteers. METHODS AND MATERIALS The data and subsidiary results of 12 normal right-handed volunteers who participated in an institutional review board-approved diffusion tensor imaging study were evaluated. The SLF fibers were obtained bilaterally placing a region of interest at the triangular-shaped region lateral to each of the corticospinal tracts, in a coronal plane along the rostral aspect of the corpus callosum. A sagittal fractional anisotropy image was used to determine the rostral endpoint of the SLF fibers in the white matter pertaining to specific gyri or pars of the frontal lobe. The SLF projection to Brocas area was ranked qualitatively as none, minimal, most or all. Findings are presented in descriptive statistics. RESULTS The SLF projection to Brocas areas was absent in seven subjects (58.3%) and minimal in five (41.6%). SLFs rostral end points were found uniquely or mainly in the precentral gyrus in 100% of cases. CONCLUSION The SLF was found connecting the posterior language areas to the precentral gyrus and only marginally in some cases to the canonical Brocas area. This finding is consistent with reports describing lack of correlation between lateralization of the SLF and language areas. The understanding of language circuitry is beginning to emerge with the use of tractography.

The Language Connectome: New Pathways, New Concepts

The field of the neurobiology of language is experiencing a paradigm shift in which the predominant Broca–Wernicke–Geschwind language model is being revised in favor of models that acknowledge that language is processed within a distributed cortical and subcortical system. While it is important to identify the brain regions that are part of this system, it is equally important to establish the anatomical connectivity supporting their functional interactions. The most promising framework moving forward is one in which language is processed via two interacting “streams”—a dorsal and ventral stream—anchored by long association fiber pathways, namely the superior longitudinal fasciculus/arcuate fasciculus, uncinate fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and two less well-established pathways, the middle longitudinal fasciculus and extreme capsule. In this article, we review the most up-to-date literature on the anatomical connectivity and function of these pathways. We also review and emphasize the importance of the often overlooked cortico-subcortical connectivity for speech via the “motor stream” and associated fiber systems, including a recently identified cortical association tract, the frontal aslant tract. These pathways anchor the distributed cortical and subcortical systems that implement speech and language in the human brain.

Cognitive testing toward the future: The example of Semantic Verbal Fluency (ANIMALS)

We are proposing that, in the future, tests included in psychological and neuropsychological batteries should fulfil the following criteria. (1) Have a large enough normative database (“normative criterion”). Performance of subjects of different ages and different educational levels, including illiterates, should be well established. Normative data from different countries and cultural contexts should be available. (2) Know the effects of brain damage on different characteristics on the test (“clinical criterion”). (3) Know how the brain is activated when the test is performed (“experimental criterion”). (4) Know how this test correlates with other cognitive tests (“psychometric criterion”). Few contemporary tests fulfil all these criteria. A notable exception is Semantic Verbal Fluency test using the category ANIMALS. This test requires the generation of words corresponding to a specific semantic category, such as animals, fruits, vegetables, etc. Typically, the number of correct words produced in 1 minu...

False lateralization of language cortex on functional MRI after a cluster of focal seizures

fMRI can define language cortex but its limitations are not yet fully understood. This article describes a child in whom fMRI falsely lateralized language cortex when performed after a cluster of left temporal lobe seizures. Multiple language tasks revealed no activation over the left temporal lobe despite a normal neurologic exam at the time of the study. A second fMRI performed 2 weeks later activated sites predominantly over the left, which were confirmed by extra-operative functional language mapping. fMRI may be unhelpful after frequent seizures.

Sub-patterns of language network reorganization in pediatric localization related epilepsy: A multisite study

To study the neural networks reorganization in pediatric epilepsy, a consortium of imaging centers was established to collect functional imaging data. Common paradigms and similar acquisition parameters were used. We studied 122 children (64 control and 58 LRE patients) across five sites using EPI BOLD fMRI and an auditory description decision task. After normalization to the MNI atlas, activation maps generated by FSL were separated into three sub‐groups using a distance method in the principal component analysis (PCA)‐based decisional space. Three activation patterns were identified: (1) the typical distributed network expected for task in left inferior frontal gyrus (Brocas) and along left superior temporal gyrus (Wernickes) (60 controls, 35 patients); (2) a variant left dominant pattern with greater activation in IFG, mesial left frontal lobe, and right cerebellum (three controls, 15 patients); and (3) activation in the right counterparts of the first pattern in Brocas area (one control, eight patients). Patients were over represented in Groups 2 and 3 (P < 0.0004). There were no scanner (P = 0.4) or site effects (P = 0.6). Our data‐driven method for fMRI activation pattern separation is independent of a priori notions and bias inherent in region of interest and visual analyses. In addition to the anticipated atypical right dominant activation pattern, a sub‐pattern was identified that involved intensity and extent differences of activation within the distributed left hemisphere language processing network. These findings suggest a different, perhaps less efficient, cognitive strategy for LRE group to perform the task. Hum Brain Mapp, 2011.

Evidence-based medicine: neuroimaging of seizures

Evidence-based medicine is useful in epilepsy and neuroimaging (Figs. 1 and 2). An understanding of the pretest probability suggests that focal neurologic deficits are important in predicting the outcome of neuroimaging examinations. In cases of nonacute symptomatic seizures, confusion and postictal deficits should prompt MR evaluation. In remote symptomatic seizures, MR imaging should be performed in a child with unexplained cognitive or motor delays or a child less than 1 year of age. Patients with partial seizures, abnormal EEG, or generalized epilepsy also should be imaged. Acute seizures should be imaged with CT to exclude hemorrhage and because of the availability and speed of the modality. Ictal SPECT is the best neuroimaging examination to localize seizure activity. MR imaging can offer prediction of surgical outcome and may hold promise in the future for dimensional localization of seizure focus. Evidence-based medicine can only work if there is physician communication. The pretest probability is helpful only when an accurate history is provided to the consulting physician. This field will flourish if physicians can develop accurate methods of collating information and reporting it in a timely fashion in the literature.

Neural Networks of Motor and Cognitive Inhibition are Dissociated Between Brain Hemispheres: An fMRI Study

Paradigms exploring cognitive inhibition involve motor responses, which may confound the results. We compare cognitive inhibition activation obtained without motor involvement, to motor inhibition alone, in a group of young right-handed volunteers, utilizing a classical color Stroop task (CST), and a Stop Task. Comparison of fMRI activation was performed contrasting lateralization indexes of different Regions of Interest (ROI). Cognitive inhibition showed left brain lateralization, while motor inhibition showed right brain lateralization. Homologue brain areas involved the inferior frontal gyrus, inferior parietal lobule, middle temporal gyrus, and anterior cingulate gyrus. These circuitries appear to support that inhibition is a complicated function involving working memory, attention, semantic decision, and motivation modules.

What can be localized in the brain? Toward a "factor" theory on brain organization of cognition.

A theoretical integration attempt among the lesional (neuropsychological), physiological (functional), and psychometric models of cognition is presented in this article. Recent neuroimaging techniques particularly fMRI have shown that there are some brain functions (i.e., simple) that can be localized into single brain areas whereas there are others (i.e., complex) that cannot. Clinical neuropsychology has been able to propose some “cognitive factors” based on empirical observations in patients with brain lesions. Factor analysis in psychometry may provide an additional tool to extract some constitutive elements of psychological functions (factors). “Factors” in factor analysis, however, may have different levels of specificity. Some times they refer to functional systems (complex cognition); in other occasions to elements of cognition (“cognitive factors”). It is emphasized that the very same brain areas (and cognitive factors) may be potentially involved in different types of cognition. It is proposed that complex cognition depends on specific patterns of activation of different brain areas and specific circuitries (“modules”), each one making its own contribution to the whole system (functional system). Impairment in a specific cognitive factor, on the other hand, may result in diverse types of impairments. At the moment, it seems feasible to suppose some cognitive factors responsible for normal neuropsychological performance. Theoretically, the impairment in any of these factors could be responsible for some specific neuropsychological syndromes.

Language and Visual Perception Associations: Meta-Analytic Connectivity Modeling of Brodmann Area 37

Background. Understanding the functions of different brain areas has represented a major endeavor of neurosciences. Historically, brain functions have been associated with specific cortical brain areas; however, modern neuroimaging developments suggest cognitive functions are associated to networks rather than to areas. Objectives. The purpose of this paper was to analyze the connectivity of Brodmann area (BA) 37 (posterior, inferior, and temporal/fusiform gyrus) in relation to (1) language and (2) visual processing. Methods. Two meta-analyses were initially conducted (first level analysis). The first one was intended to assess the language network in which BA37 is involved. The second one was intended to assess the visual perception network. A third meta-analysis (second level analysis) was then performed to assess contrasts and convergence between the two cognitive domains (language and visual perception). The DataBase of Brainmap was used. Results. Our results support the role of BA37 in language but by means of a distinct network from the network that supports its second most important function: visual perception. Conclusion. It was concluded that left BA37 is a common node of two distinct networks—visual recognition (perception) and semantic language functions.